Wednesday, May 23, 2007

Zagreb ER

Today we visited the hospital in Zagreb. It is the only major hospital in the city, and also receives patients from all over Croatia, as it is the only hospital in the country with a trauma center and a burn unit. The hospital also specializes in spine and pelvis surgery. The first thing that we noticed upon arrival was that it was hot and small. The air conditioner was under-used, but this seems to be a tendency throughout the entire country, which may be due to lack of funding as opposed to the desire to save energy. Our group spoke directly to the director of the hospital, and then we were divided into two groups. One group went to view the ambulance bay and ER, and one group went to the outpatient part of the hospital to view some minor wound care. I personally was in the group to witness the wound care, and there were several things that I noticed. We were required to don scrubs and face masks before entering the room, and there was a nurse present at all times, according to strict policy. The doctor was very thorough about cleaning the wounds, using four different types of antiseptic solutions. They were also very fast with their work. We witnessed the doctor stitch up a cut finger on one man, and then drain a hematoma on another in about 15 minutes. We also noticed that their records are all computerized, which is very advanced technology, as the United States has only recently switced to this.

Next we viewed the intensive care unit and the burn unit (both groups got to do this). The equipment in the ICU was state of the art and our professor remarked that they use the same machines in the United States. There seemed to be a lack of privacy, however, as the beds were not separated by curtains and were placed very close to each other. There also seemed to be a problem with space, as there were only about 12 beds, and the room was filled to capacity. In this room we learned the importance of time and place in relation to the likelihood of survival in an accident. There was a woman who had been hit by a tram right outside the hospital. Had she been any further away, she would have died. This is an important consideration because the hospital is the only one in Croatia with a trauma center, and many cities and villages are many hours away. Transportation to the trauma center in a timely fashion could mean the difference between life and death for many accident victims. There are some helicopters that will airlift people to the centers from some of the islands or remote locations, but are not abundant enough to solve the problem. We also learned that many of the accidents that occur in Croatia are seasonal agricultural injuries, such as falling off of a ladder while picking cherries. This could mean that the ICU ward would be more full during these periods, which could lead to problems with the space issue.

The burn unit that we toured was state of the art and brand new. While visiting this area, we learned some important facts about burn victims. The most common victims are usually old or disabled, and suffer burns while at home, such as falling onto a hot stove. Diabetics are also susceptible to burns; there was a man in the unit who was a diabetic and scalded his leg because he could not feel the temperature of the water. The most severe burn victims in the hospital were victims of traffic accidents, and had been burned in their cars. We also learned that advances in burn care, as well as orthopedics, tend to happen in times of war. Croatia experienced war in the early 1990s, so advances have recently been made.

The visit was extremely informative and educational, and our group left feeling as though we had learned a great deal about Croatia's healthcare system and quality of medical care. We would not have been able to tour the same facilities in the United States, so we were very grateful for this opportunity. Overall, we felt that the aesthetic issues were troublesome (the building is very old, so it appeared unclean and rundown in spots), but that the quality of care and technology are up to par with other nations in European Union, which Croatia hopes to join in the next few years.

Tuesday, May 22, 2007

Eastern Croatia

UGA Study Abroad in Croatia
Park in Zagreb

May 19
We visited the city of Jasenovac where we toured a WWII concentration camp museum. This was quite a disturbing and somber experience. The museum has recently been renovated and does a phenomenal job of honoring the lives that were taken in the concentration camp. Every aspect of the museum was very well thought out and includes much attention to detail, such as the smell resembling that of the camp; the displays located near the floor so visitors must bend down to see them which shows respect for the deceased; and there were many video accounts of the tragedy that help the visitor feel more of what these people must have gone through in the camp. Most of the death that occurred in the camp was from blunt trauma but disease was rampant and also claimed many lives.

The owner performing for us in Lonjsko Polje

From Jasenovac we enjoyed a delicious home-cooked meal on a farmstead in Lonjsko Polje. The owners have won several awards for their contributions to rural economic sustainability, which is a huge economic issue Croatia is facing. Ninety five percent of tourism in Croatia is on the coast, so the continental portion of Croatia is in dire need of economic influx. We enjoyed petting the animals and talking to the owners who gave us a full tour of their historic home.
From Lonjsko Polje, we continued east to Osijek, where we were able to observe the change in scenery to lush, agricultural fields of grapes, corn and other cash crops. From the bus, we also observed the large number of Croats tending their fields manually. However we did see several tractors that were also used to raise the crops. This eastern area of Croatia is the "bread basket" and produces the agricultural goods for most of the country.

May 20
After spending the night in Osijek, we proceeded to Vukovar, where we were able to see the massive devastation of the recent war in 1991. The city of Vukovar was under heavy fire during the war because it sits on the Danube River which forms a border between Croatia and Serbia. The remaining bullet-splattered buildings can almost tell the story without any words. This war left thousands of maimed and disabled war veterans and innocent citizens. Although the country is making some strides in accommodating persons with disabilities, it has a long way to go. We observed many uneven roads with few ramps that would make traversing the city for anyone with a physical disability quite difficult. As a result of the recent war, the Croatians have learned a great deal about trauma care and are well advanced in the area now. In the next post, we will tell all about our visit to the Zagreb emergency room. Because the war is of recent history, many Croats are unable to talk about it and have not been able to move past the intense pain of the travesty. This makes the rebuilding process quite a slow endeavor.
We visited the sight of a large massacre of over 200 innocent hospital patients, doctors and nurses. This was another very somber moment for us as we tried to imagine the atrocity of such ethnic warfare and genocide.

Monday, May 21, 2007

Visit to the villages

Since our arrival in Croatia, we have had the opportunity to sample life in both the big city and in the small villages. The city of Zagreb is modern and bustling, with tastes of a typical European city. There are flower markets and vendors throughout the multiple city squares, outdoor cafes which are always heavily populated, and fruit and vegetable markets with every imaginable variety of produce available. Unlike most American cities, you will not find health clubs or gyms, and you will rarely see people jogging on the streets. This is likely because, walking is the primary mode of transportation in the city. We were told by some of the locals that the mountain behind the city is one recreational site and that people often bicycle, hike, or jog there.
On Day 3, we visited several villages in Zumberak, a mountainous area about an hour's drive from Zagreb. This area in particular, is a site of intensive study by The University of Zagreb and The University of Georgia. Many of the towns here are experiencing negative population growth and some actually have zero population. Most of the remaining citizens are elderly and continue life in the traditional way, by farming and raising cattle. The young people have to leave the villages to attend school and generally, do not return to take up the trades of their relatives. As Croatia strives to gain membership in the European Union and to become a recognized tourist destination, there is also a strong push to preserve culture and tradition. As such, the UGA and UZ cooperative are hoping to promote sustainable economic development in rural regions through tourism that focuses on the history and culture of the Croatian countryside. There are other issues centered around giving the current citizens of this region access to needed services, such as health care, and this of course, will need to be addressed before bringing large numbers of visitors to the area.
Crystal cutting is one trade that is a major source of income, both from tourists and locals, in Croatia. We visited a small factory that better resembled a house, just outside of a small town. We were able to observe 2 men practicing their trade and carving crystal into glasses and bowls on a machine that looked similar to a key-cutter. They worked by the light from the windows and wore no respiratory or ear protection, despite the heavy concentration of dust in the room and shrill noise given off by the carving machines. We did see the workers take a break for about 20 minutes, but one wonders how often this happens during the course of a work day.
We briefly toured Mrzlo Polje, a beautiful, mountainous area where the University of Georgia is planning to establish a study and research center for students and faculty. Interestingly, this area is on the border with Slovenia, which has already gained admission to the EU. There are issues with illegal border crossings here since there are no strongly organized border patrols. There is also an issue involving sex trafficking across the Balkans and EU states, again, as a result of inadequate border enforcement.
After our day of touring, we were fed at a vineyard in the wine country of Zumberak. There we experienced Croatian hospitality first-hand. It was clear to us, that food is one of the most important ways to convey welcome in the Croatian culture. We were greeted at the door with drinks, cheese, and a freshly baked loaf of bread. The food was cooked in front of us and our meal consisted of several courses, including soup, salad, meat and potatoes, and dessert. The atmosphere resembled a large, family gathering, more than a restaurant setting and it was of the utmost importance to our hosts that everyone was well-fed.
The day after we returned to Zagreb, we visited the medical school at The University of Zagreb and learned about the training process for physicians in Croatia. Students enter medical school immediately after high school, following completion of an entrance exam. Medical school coursework is generally completed after 6 years, including an internship (similar to a residency in the U.S.). Most medical students however, go on to specialize, which requires another 6 years of coursework. Public health education is a part of the medical school coursework. Most physicians in the country practice in a public setting, such as a hospital or medical clinic and only a small portion go into private practice. The universities in Europe, including The University of Zagreb are currently undergoing the Bologna Process, which will provide a curriculum and time standard for Bachelor's, Master's, and Doctoral degrees. This will allow schools in Europe to be more competitive with higher learning institutions in England and America and will allow students'' credentials to be recognized in any European nation.
We also visited the Stampar Institute, which is the major institution of public health in Croatia besides the Ministry of Public Health. There we briefly learned about the structure of the public health system in Croatia, which is basically a socialized system. Health insurance is mandated for all citizens, and generally provided by employers. For those who are not employed, there is a social program similar to Medicare that provides care. It was apparent to us that the health care system of this country is still very much in transition, as Croatia is still working to refine its policies and infrastructure. Public health though, is an important part of the structure. Stampar himself, for whom the Institute is named, believed that an investment in the health of the population is an investment in the economic future of the country.